Question: My pain management practice is using two forms of risk assessment questioning for our pain management patients. One is computer-based with staff assistance. The other is done on paper and interpreted by the provider. We were using 96103 (Psychological testing [includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI], administered by a computer, with qualified health care professional interpretation and report) for the computerized risk assessment. However, the 2019 codes are completely different. Can we code 96146 (Psychological or neuropsychological test administration, with single automated, standardized instrument via electronic platform, with automated result only) for the automated testing and scoring and 96160 (Administration of patient-focused health risk assessment instrument [eg, health hazard appraisal] with scoring and documentation, per standardized instrument) for the paper risk assessment that is scored by the provider?

Question:At the doctor’s office where I work, the patients are often the friends or family members of staff members who assist with the exams. Yesterday, a coworker and I were preparing the charts for the day with our assigned doctor, and my coworker, Jane, told me that one of the patients we were seeing that day was the boyfriend of another coworker, Jill. Later, I happened to be having lunch with Jill in our break room, and she was talking about her boyfriend. I mentioned to her that Jane told me Jill’s boyfriend was coming in for his appointment and asked if Jill was planning on assisting his doctor during the exam. Jill was furious at Jane’s disclosure and said that she would be filing a formal complaint regarding a HIPAA violation. Is this really a HIPAA violation? Could my job really be in jeopardy?

Question: I started receiving denials on some of my flu vaccine claims, and my Medicare administrative contractor (MAC) indicated that it couldn’t price the vaccine because I was missing the “NDC.” What is this, and how do I know when to use it?

Question:I’m confused by vaccine coverage when some of the shots aren’t covered by my payer. For instance, I’m getting denials on tetanus vaccines. How do I know which ones are covered? And what should I do when a patient comes in needing a shot that my practice may not get paid for?

Question: The orthopedic surgeon performed a total shoulder arthroplasty to treat a fracture (code 23472) and in the same encounter, did an open treatment of a proximal humeral fracture (23615) and a biceps tenodesis (23430). Yet codes 23615 and 23430 are bundled as components of 23472 by National Correct Coding Initiative (CCI) edits.This is leading some at our practice to wonder whether it would be better to just submit the fracture reduction and tenodesis codes and skip billing for the arthrodesis. What is the correct response?

Question:We have a commercial payer that dropped a sudden rate change on us with no notice; we only found out via a paid claim. The payer says it notified us of the change 30 days before the date by which we had to approve it, but we never received any notice at all. How can the payer expect to get away with this?

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